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Technology transforms diabetes

'The Palmer Injector', Glasgow, Scotland, 1955-1965

'The Palmer Injector', Glasgow, Scotland, 1955-1965

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Technology can transform the experience of diseases: a life-threatening condition can be turned into a manageable ‘chronic’ - long-term - condition. This is the case for many with type 1 diabetes, whose health depends on insulin-injecting devices. Patients with type 1 diabetes are unable to produce the essential hormone insulin, and without it the body cannot turn sugar from food into energy needed to live.

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Injecting insulin

Banting and Best discovered insulin in 1922. Before then, prospects for diabetic patients were bleak. Some managed their condition through strict diets. Banting and Best showed patients could take animal insulin to replace their missing hormone. The first insulin injection was given to 14-year-old Leonard Thompson at Toronto General Hospital, Canada, on 23 January 1922. Regular insulin injections meant patients like Leonard could live normal healthy lives, but ones reliant on devices.

Managing diabetes at home

Managing diabetes back then was difficult. Insulin must be delivered straight into the bloodstream, and in the early days the only way to do this was with a hypodermic needle and syringe. Patients initially went to doctors for injections, but the need for several injections a day made this impractical. Patients were given equipment so they could manage their condition at home without doctors.

Insulin injections could be extremely painful and inconvenient. To stop needles getting blunt (making injections more painful), pumice stones were used to sharpen them. Patients also used sterilising equipment to clean needles after each injection.

New devices helped people with diabetes inject insulin. In 1955 a diabetic called Charles Palmer invented the Palmer injector to make self-administered injections easier. In 1985 insulin injection pens were introduced. These are discreet and convenient, and they ‘click’ when the right dose is reached.

As well as giving themselves injections, patients monitored their sugar levels so they knew how much insulin to take. Initially only urine glucose tests were available. Testing urine could be messy and inconvenient. In the 1980s new blood glucose monitors let patients test their blood for sugar. Most people with diabetes preferred these.

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Alternatives to injections

An alternative to injections was not developed until the 1960s. The first insulin pump was the AutoSyringe. It was pioneered by American doctor Arnold Kadish and known as the ‘big blue brick’. The first model was so large it had to be worn like a backpack. Instead of an injection, pumps deliver frequent small doses of insulin directly into the abdomen. By the 1990s the devices were small and portable. Some diabetics, particularly children, prefer pumps because they do not require painful injections. They also give greater control over the amount and frequency of insulin taken.

Experts at managing illness

Diabetic patients are often called ‘expert patients’ because they manage their illness largely by themselves. Being in control of their condition means they need less support from medical practitioners.

Scientists are still searching for new ways for patients to take insulin. Inhalers, patches and pills are all alternatives to injections.

Bibliography

M Bliss, The Discovery of Insulin (Chicago: University of Chicago Press, 2007)

R Cobb, Diabetes: fifty years with the needle - my life with insulin therapy (New York: Vantage Press, 1996)

C Feudtner, Bittersweet: diabetes, insulin, and the transformation of illness (Chapel Hill: University of North Carolina Press, 2003)

N Fox, K Ward and A O’Rourke, ‘The ‘expert patient’: empowerment or medical dominance? The case of weight loss, pharmaceutical drugs and the Internet’, Social Science & Medicine, 60 (2005), pp 1299-1309

J Macleod, 'History of the researches leading to the discovery of insulin', Bulletin of the History of Medicine, 52 (1978), pp 295-312

O Pillai and R Panchagnula, ‘Insulin therapies – past, present and future’, Drug Discovery Today, 6 (October 2001), pp 1056-61

J Shaw and M Baker, ‘Expert patient: dream or nightmare?’ British Medical Journal, 328 (2004), pp 723–4

Glossary:

Diabetes

This term refers to any form of metabolic disorder characterized by extreme thirst and excess urine production.